Prevention of postoperative delirium - A prospective nurse-led intervention on surgical wards in a general hospital

Abstract

Objective

Delirium is a frequent postoperative complication in older and cognitively impaired patients in general hospitals. Delirium is associated with prolonged hospital stay as well as with an increased risk of nursing home placement after discharge. We wanted to study whether the implementation of a specialized delirium nurse on a surgical ward leads to a reduction in the frequency of postoperative delirium.

Methods

In an open-label study on two surgical wards of a general hospital, first the prevalence rate of postoperative delirium in patients older than 70 years was assessed (March to August 2011). During the following intervention phase (September 2011 to June 2012), a trained geriatric nurse implemented delirium-preventative measures in accordance with the Hospital Elder Life Program (HELP). The second surgical ward provided standard treatment as usual as an in-house control.

Results

Overall 20.2%, 95% CI [14.6, 26.4] of patients on both wards without special intervention developed postoperative delirium. By implementing preoperative screening measures and specific interventions by a delirium nurse, the incidence of postoperative delirium was reduced to 4.9%, 95% CI [0.0, 11.5]. The interventions were validation, improving sleep quality, cognitive activation, early mobilisation, improving sensory perception and optimising food and fluid intake. Most important predictors of postoperative delirium were Mini Mental Status Exam results, age and preoperative infection.

Conclusion

The establishment of a specialised delirium nurse as well as the implementation of simple preoperative care measures increased postoperative attention, cognitive activation and is associated significantly with reducing risk of postoperative delirium in older and cognitively impaired inpatients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.